Confusion Assessment Method
Brief delirium assessment tool based on DSM-III-R criteria.
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The Confusion Assessment Method (CAM) is a diagnostic tool developed to allow physicians and nurses to identify delirium in the healthcare setting. It was designed to be brief (less than 5 minutes to perform) and based on criteria from the third edition-revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). The CAM requires that a brief cognitive test is performed before it is completed. It has been translated into more than 20 languages and adapted for use across multiple settings.
Quick Facts
- Sensitivity (original study)
- 94-100%
- Specificity (original study)
- 90-95%
- Real-world clinical practice sensitivity
- 30-40%
Facts from the source article.
Elements of Score
The CAM has short and long forms. The short form assesses four features: acute onset or fluctuating course, inattention, disorganized thinking, and altered level of consciousness.
The long form adds disorientation, memory impairment, perceptual disturbances, psychomotor agitation or retardation, and altered sleep-wake cycle. Each feature is scored as present or absent. Delirium is present if acute onset or fluctuating course and inattention are present, plus either disorganized thinking or altered level of consciousness.
Interpretation
When first tested, the Confusion Assessment Method (CAM) was compared to a psychiatrist’s evaluation using DSM-III-R criteria, yielding a sensitivity of 94-100% and specificity of 90-95%. A review of seven high-quality studies with over 1,000 patients reported a sensitivity of 94% and specificity of 89%.
Another review of 22 studies with over 2,400 patients found a sensitivity of 82% and specificity of 99%. A 2019 trial comparing CAM to the 4AT tool found CAM had lower sensitivity, with similar specificity. In routine clinical practice, however, large-scale studies indicate CAM’s sensitivity drops to around 30-40%.
More in Mental Disorders Screening and Assessment Tools
Sources
Compiled from Wikipedia and the sources listed below. Text from Wikipedia is available under CC BY-SA 4.0; this entry is adapted from it.
- Wikipedia: Confusion Assessment Method (CC BY-SA 4.0).
- Word definitions: the Codexery glossary, each quoted from its Wikipedia article.
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